Proposal for effective treatment of Shiga toxin-producing Escherichia coli infection in mice

Previously, we reported that minocycline, kanamycin and norfloxacin improved the survival rate in the E32511 model that we developed (Infect. Immun. 62: 3447-3453, 1994), but fosfomycin did not. In this study, we investigated the effectiveness of azithromycin (AZM) against Stx2d-producing EHEC O91:H21 strain B2F1 or Stx2c producing Escherichia coli strain E32511 treated with Mitomycin C in vivo. Recently,we reported the effectiveness of AZM in our model and AZM strongly inhibited the release of Stx2c from E32511 in vitro (PLOS ONE e58959, 2013). However, it was very difficult to completely eliminate E32511 in the mouse feces by treatment with AZM alone. In this report, only AZM or Daio effectively promoted survival of mice infected with B2F1 compared to untreated mice. Furthermore, Daio inhibited the colonization of GFP expressing B2F1 in the mouse intestine. Similarly, a combination of AZM and Daio in the E32511-infected mice reduced E32511 in the mouse feces and significantly improved survival

Investigation of encephalopathy caused by Shiga toxin 2c-producing Escherichia coli infection in mice

A large outbreak of Shiga toxin (Stx)-producing enteroaggregative Escherichia coli (EAEC) O104:H4 occurred in northern Germany. From this outbreak, at least 900 patients developed hemolytic uremic syndrome (HUS), resulting in more than 50 deaths. Thirty percent of the HUS patients showed encephalopathy. We previously established a mouse model with encephalopathy associated with blood brain barrier (BBB) damage after oral infection with the Shiga toxin (Stx) 2c-producing Escherichia coli O157: H- strain E32511 (E32511). In this model, we detected high expression of the Stx receptor synthase enzyme, glycosphingolipid globotriaosylceramide (Gb3) synthase, in endothelial cells (ECs) and neurons in the reticular formation of the medulla oblongata by in situ hybridization. Caspase-3 was activated in neurons in the reticular formation of the medulla oblongata and the anterior horn of the spinal cord. Astrocytes (ASTs) were activated in the medulla oblongata and spinal cord, and a decrease in aquaporin 4 around the ECs suggested that BBB integrity was compromised directly by Stx2c or through the activation of ASTs. We also report the effectiveness of azithromycin (AZM) in our model. Moreover, AZM strongly inhibited the release of Stx2c from E32511 in vitro

Case Series of Pre-Operative Endovascular Embolization of Nasopharyngeal Angiofibroma Using Polyvinyl Alcohol Foam Particle: A Single Centre Experience

BACKGROUND: Nasopharyngeal Angiofibroma is a rare neoplasm in the sphenopalatine foramen. This tumour is histologically benign, but clinically malignant because it can erode the bone and surrounding structures, such as the pterygopalatine fossa, paranasal sinuses, and nasal cavity. It is a highly vascular tumour, sometimes from multiple Feeding arteries, and tends to bleed easily. CASE PRESENTATION: In these cases, series, we reported four cases of nasopharyngeal angiofibroma in children and one case in an elderly patient. The diagnosis was made by history taking, physical examination and Cerebral MSCT Angiography, as well as Digital Subtraction Angiography (DSA). After identification of the Feeding artery, we performed transarterial embolisation using polyvinyl alcohol (PVA) foam particles. CONCLUSION: Preoperative embolisation in the highly vascular tumour, such as nasopharyngeal angiofibroma, is very useful to reduce peri-operative complication of surgery. This procedure can reduce blood loss during resection of the tumour and gives better outcomes

Symptomatic Intracerebral Hemorrhage Complicating Intra-Arterial Mechanical Thrombectomy in Acute Ischemic Stroke

BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. The endovascular treatment of AIS depends on stroke subtype, whether caused by large vessel occlusion (LVO) or not. We presented a case of AIS due to LVO that has complication in the form of symptomatic intracerebral hemorrhage (sICH) after an intra-arterial mechanical thrombectomy. CASE PRESENTATION: An 80-year-old woman was admitted to the emergency department with sudden onset left side weakness since <1 h before admission, when the patient had woke up in the morning. The patient had history of hypertension, diabetes mellitus, and dyslipidemia. She also had cardiac disorders in the form of non-valvular atrial fibrillation with 55% left ventricular ejection fraction (LVEF). Her blood pressure was 148/84 mmHg, heart rate was 65 beats/minute, respiratory rate was 17 times/min, and body temperature was 36.2°C. Glasgow coma scale (GCS) was E3V4M5; National Institutes of Health Stroke Scale (NIHSS) was 15. She had moderate aphasia. Head CT scan did not show any hyper- or hypodens areas and Alberta Stroke Program Early CT score was 10. RAPID automated CT perfusion using Quantitative Software showed that the mismatch volume was 192 ml and the mismatch ratio was 7.4. Endovascular therapy in the form of intra-arterial mechanical thrombectomy was performed, and blood flow in the right internal carotid artery (ICA) was restored with the score of Modified Thrombolysis in Cerebral Infarction (mTICI) was III. Follow-up non-contrast head CT scan was performed and revealed acute infarction with hemorrhagic transformation in the middle cerebral artery (MCA) territory. CONCLUSION: Early and accurate treatment of AIS is paramount. Endovascular treatment in the form of intra-arterial mechanical thrombectomy is the current treatment recommendation in LVO although there is a risk of symptomatic intracerebral hemorrhage, as in this case

Infark serebri akibat trombosis sinus rektus menyerupai sebagai abses serebri bilateral pada talamus: Sebuah laporan kasus dan tinjauan pustaka

Pendahuluan: Cerebral venous sinus thrombosis (CVST) atau trombosis vena sinus serebral merupakan kasus penyakit serebrovaskuler yang jarang terjadi dengan gejala klinis dan gambaran radiologis yang bervariasi serta sangat sulit untuk di diagnosis. Disini kami melaporkan kasus seorang ibu post partum dengan infark serebri pada area bilateral talamus dan di misdiagnosis dengan abses serebri. \ud Laporan kasus: Seorang ibu, 24 tahun masuk ke instalasi rawat darurat (IRD) rumah sakit Dr Wahidin Sudirohusodo (RSWS) dengan penurunan kesadaran disertai dengan gelisah dan tidak bersuara sejak 2 hari yang lalu. Disertai dengan mual, muntah, sebanyak 5 kali, dan pada saat tersebut juga pasien sulit untuk membuka mata disertai perasaan lemah. Dari hasil pemeriksaan radiologisnya (CT-Scan kepala) didapatkan area hipodens pada daerah bilateral talamus utamanya sebelah kanan yang menyarankan abses serebri terutama kanan dan hasil dari CT arteriografi dan venografi serebral menunjukkan adanya filling defect pada sinus rektus, sinus transversus kiri sampai dengan vena jugularis kiri yang menyarankan sebuah trombosis pada sinus rektus serebral. Setelah dilakukan terapi selama 2 bulan yang meliputi antibiotik dan warfarin dilakukan CT Scan kepala kontrol hasil menyarankan sebuah infark serebri pada area talamus. \ud Kesimpulan: Diagnosis CVST sangat penting dan harus dilakukan secara menyeluruh dengan melibatkan aspek meliputi: anamnesis, pemeriksaan klinis neurologi dan pemeriksaan radiologis serta pemeriksaan penunjang lainnya seperti laboratorium. Dan area infrak cerebri pada hasil pemeriksaan radiologis dalam hal ini CT-Scan kepala harus dipikirkan berdasarkan distribusi vena-vena serebral bukan hanya distribusi arteri-arteri serebral

A robust allegation of von Hippel-Lindau (VHL) associated haemangioblastoma in the central nervous system (CNS) : A case report

Haemangioblastoma, a benign vascular tumor derived from the capillary of endothelial cells, is an inherited\ud disorder due to an autosomal dominant trait. The prevalence rates accounted for 1% to 2.5% of all intracranial tumors and 2%\ud to 3% of all intramedullary spinal cord tumors. We report the infrequent case of a robust allegation of von Hippel-Lindau\ud (VHL) associated haemangioblastoma in the central nervous system of a man. A 20 years old male presented to the hospital\ud with the chief complaint of progressive chronic cephalgia three months prior to hospitalization. He complained also of\ud blurred vision on neurologic examination; there is papilla edema with suspicion of retinal edema. Radiological examination\ud result suggested a cerebellar haemangioblastoma dextra with noncommunicating hydrocephalus. After the first operation\ud (installation of VP shunting) and subsequent operation (excision of the tumor), the pathological anatomy results revealed a\ud cavernous angioma

HUBUNGAN ANTARA PENGGUNAAN OBAT ATORVASTATIN TERHADAP PERBAIKAN KLINIS PASIEN STROKE ISKEMIK DI RSUP DR. WAHIDIN SUDIROHUSODO

Indonesia menduduki terbanyak di Asia yang menderita stroke. Statin dengan efek pleiotropiknya dapat menjadi neuroprotektan sehingga dapat memperbaiki kondisi klinis dan mencegah terjadinya stroke berulang, Di rumah sakit ataupun di klinik ada pasien yang mendapatkan terapi atorvastatin dan ada pula yang tidak. Penelitian ini bertujuan menganalisis efektivitas atorvastatin terhadap pasien stroke iskemik dengan menganaisis nilai kolestrol total, HDL, LDL, dan atorvastatin terhadap perbaikan klinis pasien dengan pengukuran nilai gcs dan mRS.Desain penelitian yang digunakan adalah observasional non eksperimen deskriptif-analitik. Pengambilan sampel dengan teknik non-probability sampling dengan cara purposive sampling.Jumlah sampel 30, terdiri dari kelompok atorvastatin (15 pasien) dan kelompok tanpa Atorvastatin (15 pasien). Kolestrol total, HDL, dan LDL, dan mRS diperiksa sebelum dan setelah terapi. Data kolestrol dianalisis secara deskriptif, dan nilai mRS dianalisis dengan menggunakan Uji paried t Test. Hasil penelitian menunjukkan terjadi penurunan nilai kolestrol total (25 %) dengan nilai rata-rata 194.80  dan setelah terapi 151.40, sedangkan untuk nilai HDL tidak terjadi peningkatan,  sebelum terapi (31.00 setelah terapi menjadi 27.00 , dan untuk LDL tidak terjadi penurunan yang signifikan, sebelum terapi 113.80 mg/dl dan setelah terapi menjadi 93.20, sedangkan untuk perbaikan nilai mRS, memberikan hasil mRS yang meningkat secara  signifikan dari kelompok atorvastatin (p=0.001) dibandingkan pasien yang tidak diterapi dengan atorvastatin (p=0.610). Dapat disimpulkan bahwa ada hubungan yang signifikan dari pemberian Atorvastatin terhadap perbaikan klinis pasien yang diukur dengan mRS (modified rankin scale